Growth Plate Injuries

What Is the Prognosis for Growth in the Involved Limb of a Child With a Growth Plate Injury?

About 85 percent of growth plate fractures heal without any lasting effect. Whether an arrest of growth occurs depends on the following factors, in descending order of importance:

  • Severity of the injury--If the injury causes the blood supply to the epiphysis to be cut off, growth can be stunted. If the growth plate is shifted, shattered, or crushed, a bony bridge is more likely to form and the risk of growth retardation is higher. An open injury in which the skin is broken carries the risk of infection, which could destroy the growth plate.
  • Age of the child--In a younger child, the bones have a great deal of growing to do; therefore, growth arrest can be more serious, and closer surveillance is needed. It is also true, however, that younger bones have a greater ability to remodel.
  • Which growth plate is injured--Some growth plates, such as those in the region of the knee, are more responsible for extensive bone growth than others.
  • Type of growth plate fracture--The five fracture types are described in the section, How Are Growth Plate Fractures Diagnosed? Types IV and V are the most serious.

Treatment depends on the above factors and also bears on the prognosis.

The most frequent complication of a growth plate fracture is premature arrest of bone growth. The affected bone grows less than it would have without the injury, and the resulting limb could be shorter than the opposite, uninjured limb. If only part of the growth plate is injured, growth may be lopsided and the limb may become crooked.

Growth plate injuries at the knee are at greatest risk of complications. Nerve and blood vessel damage occurs most frequently there. Injuries to the knee have a much higher incidence of premature growth arrest and crooked growth.

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